Unsatisfying factors after correcting breast ptosis

Today, I would like to share about some unsatisfying factors after the mastopexy surgery (breast ptosis, sagging breast lifting surgery)

This is not as common as breast augmentation so people have some knowledge on it from the internet but they are not aware about the dissatisfying factors that may be caused compared to the much knowledge that they have regarding the problem and side effect of breast augmentation.

The first dissatisfying factor is the shape (Peak point is rather flat)

Designing on how to correct the sagging breasts needs much skill and experience as there may be unexpected problems. There are many comments that the breasts do not look good after the lifting.




Usually we ties up the surrounding of the nipple. The nipple needs to point outwards but it stays flat at the peak point of the breast. In such case, we need to minimize the ‘scar’ caused therefore we conduct incision on the diameter of the areola and conduct lifting on the donut-like shape.

In order to prevent this flatness at the peak point, vertical incision is recommended.

Vertical incision helps fix the sagging of the skin tissue, and make the breast look in ideal shape.

If the breast gland does not sag, but only the nipple does, then we do not need to apply the vertical incision...........


The second dissatisfying factor is that you may not like to position of the nipple / areola

The nipple and the areola must be located at the peak point of the breast in order to look good cosmetically. If you disregard the position of the areola and the nipple when they are located towards the bottom of the breast and insert an implant, the implant would make the breast look larger but the nipple would fall below the breast gland facing downwards. This would end up in very unsatisfying shape of the breast.



Also, if the surgeon designs the correction so that the areola is placed too much at the top part of the breast, this would also look weird. (We call this false ptosis)

If you want to position the nipple and areola right at the peak of the breast then the surgeon must estimate how much breast tissue to lift up when designing the procedure. You need to conduct the procedure as planned to make the position correct but this may not always happen therefore leading to further correction. There are more variables if you use an implant.


The third dissatisfying factor is the size of the breast

If you have large original breast, the usage of the implant may make you dissatisfied because your breast has become too big. But if you have small original breasts and use implants, you might be happy with the size but you can be unhappy with the skin elasticity and tightness.

If you have large original breasts, then it would better off to not use the implants when conducting lifting procedure. The implant would lead to added volume that may cause more variables…


Many people think that the “scar” might be the biggest problem but amazingly, there aren’t many complaints regarding scars after the correction. (The scars tend to go away easily after the correction)


Today, we share about the unsatisfying factors that might come up after breast ptosis correction.

Thank you for reading and have a great day..

Asymmetric Breast correction - Breast surgery Korea KIES-U

Today I would like to share about asymmetric  breasts that are sagging as well.
Everyone has uneven breasts. There are various reasons for this.

The first is because the heart is on the left side therefore the left chest sticks out more than the right.. In same respect, the left and right bones of the body are different therefore both sides are uneven.

Second, is that the growth of both sides of the breasts cannot be the same. Your hands and feet are different and the same applies to your breasts also.

There are more people with asymmetric breasts than symmetric ones therefore, you can say that asymmetric breasts are rather normal.

You will be able to understand what I have shared so far, but there is one fact that those who have not experienced pregnancy cannot understand. After giving birth and completing the breastfeeding, your breasts tend to sag, and this degree of sagging is different from one person to another.






The degree of sagging and also the shape of the breast differ from one to another. Therefore, at times we must apply different methods in correcting both your breasts.

It is impossible to have same amount of breast milk provided on both your breasts. The amount of breast milk on both your breasts are different and the baby tends to like one side more than the other therefore the breasts shape different after you complete breastfeeding.

When we gather all these facts, we can conclude that the sagging is different on both your breasts, but the ladies tend to suffer much stress about it after completing the breastfeeding.

Let’s see what sagging breast really is. There is no academic standard for what sagging is but if one breast is about 2cm or more longer, we apply surgical method to correct the sagging.


Usually different methods are applied on both sides but we can also apply same method but end up with slightly different results.

How can we judge if your sagging is severe or not?

There are many ways to do this but first you need to look into the mirror and see how your breasts are located. If your breast gland is lower than the inframammary fold, then you can say that you have a severe case of sagging breast. If you cannot see the white skin under the breast than you need vertical incision breast correction.

Let’s say that your right is somewhat sagging but your left is sagging a lot. What can we do about this?

We need to pull up the left breast gland as much as possible. We can consider applying vertical incision breast correction. We need to pick a spot for the areola and first try to pull up the right breast gland in line with the picked spot for the areola.

As such, we can apply different methods for different degree of sagging breasts.



The above image shows a breast gland with much volume sagging downwards but the skin has much elasticity therefore the nipple is placed is the proper spot. We need to apply vertical incision breast correction for the breast in whole but we do not need to move the nipple as much.We do not need to use an implant in such case.



This is a case where both your breast gland and nipple are sagging. Vertical incision breast correction is necessary and we need to pull up both your breast gland and the nipple. It is possible to use an implant or not, but I do not recommend using the implant.

More sagging ; Less sagging
→ Vertical incision breast correction : Areola circumference breast correction
    Areola circumference breast correction : Dual plane breast augmentation
    Vertical incision breast correction : Dual plane breast augmentation

We can apply the same method but we can move by a little or more.

The image below shows rather an extreme case. The volume is not sagging much but the nipple looks to be sagging a lot. We can use an implant and make the nipple look higher so that it is not sagging.
 


Today, I shared about a rather difficult topic on asymmetric breast ptosis. I am sure that you can know what type of situation you are in just by looking at the images provided.

Thank you for reading. Have a great day.

Today, I would like to share about breast implant associated Anaplastic Large Cell Lymphoma (ALCL).

Many doctors, WHO and FDA have continued to study and state problems on the correlation between breast implant and ALCL.



In FDA’s report on March 22nd, it concentrated in showing significant understanding of textured implant having high correlation to side effects compared to smooth type implant.

There were many who asked if they should remove the textured implant that they used after reading this report.

But first, let’s talk about how common or rare this ALCL is.

The most knowledgeable journal in cosmetic surgery is PRS journal. In the January edition, Professor Miranda and 8 others from Texas Anderson Cancer Center published that the prevalence rate of ALCL from implant was 3 out of 100 million (0.0000030%). The prevalence rate on textured implant is 2.03 out of 1 million people (0.000203%).



The lifetime prevalence rate is 33 out of 1 million (0.00330%). This is a very rare disease.



Let’s see how dangerous ALCL is. Anderson Cancer Center report says that the survival rate within 5 years is 93~89%. This is pretty good rate compared to other severe cancers. It is defined as curable disease as well.

All reports show that the textured implant has higher prevalence rate compared to other types but this texturing method on the implant is different from one implant manufacturer to another.

The texturing process involves the usage of salt loss crystal on implant (Allergan, Cervin, etc) or negative imprint stamping on implant (Mentor). Almost all ALCL cases are found on the salt loss crystal processing.

But, we do not have enough data to conclude on this. It is because the disease is very, very, very rare. There is no way to get related information easily.

Here is the link of March 22nd FDA report and guideline. I would like to summarize the important contents.



The 231 patient records that FDA collected were reported in MDA. These records are important but unreliable and inaccurate.

Because it has generally only been identified in patients with late onset of symptoms such as pain, lumps, swelling, or asymmetry, prophylactic breast implant removal in patients without symptoms or other abnormality is not recommended.

And, they recommended routine care and support as usual for treatment.

One recommendation to the patient is,

If you have breast implants, there is no need to change your routine medical care and follow-up. BIA-ALCL is rare.

There is not one case report of BIA - ALCL in Korea.

Breast implants are not perfect, they have various problems.

But if there are more to gain from them than problems raised, we tend to use them. There is a chance of getting into an accident when driving a car, but no matter what, we do drive our cars. This is the same in some aspect.

But, I really do think that we do not need to have much fear about ALCL.

This is all for today. Have a great day. Thank you.

breast lifting surgery korea - vertical incision mastopexy

I have shared previously that the breast lifting surgery methods are different according to the degree of sagging. Today, I would like to share about the breast lifting(mastopexy) method when there is both composition and skin layer sagging.

We can conduct this procedure with or without implant.

There are various ways to design incision but the best ones are areola incision and vertical incision.

There are many who do not like the vertical incision, but this incision cannot be avoided when correcting both composition and skin layer sagging. Also, if you have sagging breasts, you have less elastic skin that results in less scars as well.

Those with clear incision scars tend to be young patients and those who did not give birth. The more elastic the skin is, the higher the chances that the scars would be worse.

Therefore, there is no reason to avoid vertical incision more the clear the sagging is. Also, it is the only way to lift the breast.



The above image is the breast lifting design for vertical incision. The areola and the nipple composition gets lifted upwards helping to correct the loss of elasticity and the sagging. But the focus should be in lifting up the actual composition of the breast.

We need to cross connect the bottom part of the breast as if we are threading our clothes and lift up the actual composition of the breast.

We need to move and lift up the sagging part when there is a such degree of sagging in order to solve this. Please remember this.





You will be able to understand how the sagging breasts are corrected when referring to the image above.

‘Lifting’ has a fixation point, and this fixation point that withstand the weight supporting is lifted upwards. (Face, neck lifting)  

There are cheekbones and temporal fascia that act as a supporting mechanism without any movement. This can act as a fixing point. But there are fat all around the breasts and these fat are not firm. It is difficult to have a fixation point.

Therefore we need to change the state of the breast tissue in order to apply the lifting method. The result of the procedure is very satisfactory except for some really difficult procedures.

Today, we talked about the vertical incision method for breast ptosis. Thank you for reading.

There are different types of sagging breasts. The correction method also changes according to the degree of sagging. Today, I would like to share different type of methods in solving the sagging breasts.

Most doctors differentiate sagging by observing the relationship between the location of the areola and the inframammary fold. (We call this Regnault’s classification)

I have shared details on the classification in my blog as well, but many people who have read it cannot actually know how their breasts are. Also, there are some exceptional cases. So, today, I would like to share just two concepts for all of you to understand easily.

Sagginess is caused by two reasons.


The first is when the composition insider the breast sag. The compositions would be tissue cells and fat. The ligament stretch out while holding the composition leading to sagging of the breast.

Let’s call this ‘composition sagging’.

Then there is a case where the outer skin stretches out leading to sagging. Let’s call this ‘skin sagging’. This is caused because the skin is not elastic. In such case, both the nipple and the areola drop downwards as well.



The composition sagging is caused because the original breast is large. The volume of the original breast is large (with much fat) which leads to quicker sagginess. There are times when the composition is sagging but the skin has much elasticity which helps to maintain the form of the breast properly. This usually happens to young women after pregnancy or after diet. The composition drops down but the young and strong skin supports this.

When the composition sags but the skin does not, we call this mammary gland ptosis. If this type of ptosis is not severe, we can use implant to correct it.

We need to move the inframammary fold line downwards therefore need to apply dual plane procedure.

Outer skin sagging without the composition sagging is very rare.

- Those women with large original breasts before pregnancy -

These women usually have composition sagging.
These women after giving birth will suffer from worse composition sagging that also leads to outer skin sagging.



- Those who had small breasts before pregnancy -

These patients do not suffer much from composition sagging after giving birth as well, because of the small original breasts.... But they suffer breasts getting bigger during pregnancy and then the loss of volume after giving birth which leads to loss of skin elasticity.

This is where there is more of outer skin sagging compared to composition sagging.

We need to fill up the inside in order to strengthen skin elasticity. The loss of volume after giving birth is familiar to a balloon with a loss of air… this can be fixed with implant. Breast augmentation is good enough as a solution.

What if your areola is positioned so low that you want to change its location. We can move the areola at the desired spot in this case.





 - A lady with somewhat large breast before pregnancy, but the breast sag after breastfeeding -

This is the most common case. It has in more than half the time. This is when there is composition sagging but not skin because the patient is still young.

As you get older and have more children, the skin starts to sag and the areola moves downwards as well. These patients need lifting correction in order to correct the composition sagging.

If the composition sagging is not severe without areola sagging, then dual plane procedure would be good enough.


As such, we need to know the degree of sagging and its form in order to provide solution for it.


There are many exercises that you can refer to on the internet in order to prevent your breasts from sagging, but in reality these exercises do not help you much.
Exercises are to make your muscles stronger, but sagging is caused when the tie between the muscle and the breast tissue becomes loose. It is not the muscle that is becoming loose.
Therefore, stronger and bigger muscle does not help avoid sagging.

Today, I share about the types of sagging breast, Thank you for reading.